NIDA Community Drug Alert Bulletin - Anabolic Steroids
Steroid
abusers often
do not realize
that over time,
these drugs
can take a
heavy toll on
their health.
Dear Colleague;
Since the 1950s, some athletes have taken anabolic steroids to
build muscles and boost their athletic performance. Increasingly,
other segments of the population also have been taking these
synthetic substances. The Monitoring the Future study, an annual
survey of drug abuse among middle and high school students
across the country, showed a significant increase from 1998 to
1999 in anabolic steroid abuse among middle schoolers. During
the same year, the percentage of 12th-graders who believed that
taking these drugs causes "great risk" to health declined from 68
percent to 62 percent.
Studies show that, over time, anabolic steroids can indeed take a
heavy toll on a person's health. Abuse of oral or injectable
anabolic steroids is associated with increased risk for heart
attacks and strokes, and the abuse of most oral anabolic steroids
is associated with increased risk for severe liver problems,
including hepatic cancer. People who share needles or use
nonsterile injection techniques put themselves at risk for
contracting dangerous infections, such as HIV/AIDS, hepatitis B
and C, and bacterial endocarditis.
Anabolic steroid abuse can also cause undesirable body changes.
Men may develop enlarged breasts and women's bodies may
become masculinized. Both sexes can develop acne and hair loss.
This Community Drug Alert Bulletin summarizes some of the
latest scientific information on anabolic steroids. NIDA also has
established a Web site to provide scientific information about
anabolic steroids: http://www.steroidabuse.org. As research produces
new information, NIDA will continue to make every effort to
quickly disseminate these findings via the Web site and
subsequent Alerts. Our objective is to keep the Nation's
communities up-to-date concerning the risks of abusing anabolic
steroids and science-based approaches to preventing and treating
such abuse.
Sincerely,
Alan I. Leshner, Ph.D.
Director
Anabolic steroids are:
Synthetic substances related to the male sex hormones (androgens). They
promote growth of skeletal muscle (anabolic effect) and the development of
male sexual characteristics (androgenic effects), and also have other effects.
(The term "anabolic steroids" will be used throughout this bulletin because of
its familiarity, although the proper term for these compounds is
"anabolic/androgenic" steroids.)
Used by doctors to treat conditions that occur when the body produces
abnormally low amounts of testosterone, such as delayed puberty and some
types of impotence, and also to treat body wasting in patients with AIDS and
other diseases.
Legally available in the United States only by prescription. Anabolic steroid
abusers obtain drugs that have been made in clandestine laboratories
(sometimes with poor quality control standards), smuggled from other
countries, or diverted illegally from U.S. pharmacies.
Distinct from steroidal supplements. In the United States, supplements such as
dehydroepiandrosterone (DHEA) and androstenedione (street name Andro) can
be purchased legally without a perscription through many commercial sources
including health food stores. They are often taken because the user believes
they have anabolic effects.
Anabolic steroid abuse is:
Increasing among adolescents, and most rapidly among females. The 1999
Monitoring the Future study, a NIDA-funded survey of drug abuse among
middle school and high school students across the United States, recorded that
2.7 percent of 8th-graders, 2.7 percent of 10th-graders, and 2.9 percent of
12th-graders reported having taken anabolic steroids at least once in their
lives. These figures represent increases since 1991 of approximately 50 percent
among 8th- and 10th-graders and 38 percent among 12th-graders.
Probably widespread among athletes and would-be sports competitors at all
levels, although few data are available to provide exact estimates of
prevalence. Many anabolic steroid abusers are unwilling to report the practice,
because the International Olympic Committee and many other amateur and
professional sports organizations have banned anabolic steroids.
Motivated in most cases by a desire to build muscles and improve sports
performance. Some individuals are motivated by erroneous perceptions of their
own bodies (that is, a mistaken belief that they look underweight or obese) and
others by a desire to prevent recurrence of physical or sexual attacks they
have experienced.
Anabolic steroids are taken:
Orally as tablets or capsules (Anadrol® [oxymetholone], Oxandrin®
[oxandrolone], Dianabol® [ methandrostenolone], Winstrol® [stanozolol], and
others); by injection into muscles (Deca-Durabolin® [nandrolone decanoate],
Durabolin® [nandrolone phenpropionate], Depo-Testosterone® [testosterone
cypionate], Equipoise® [boldenone undecylenate], and others); or by ointment
preparations rubbed into the skin. Doses taken by abusers can be up to 100
times more than the doses used for treating medical conditions.
In combinations, a practice called "stacking." Abusers frequently take two or
more anabolic steroids together, mixing oral and/or injectable types,
sometimes adding drugs such as stimulants or painkillers. The rationale for
stacking is a belief-which has not been tested by science-that the different
drugs interact to produce a greater effect on muscle size than could be
obtained by simply increasing the dose of a single drug.
In cyclic dosage regimens, a practice called "pyramiding." At the beginning of a
cycle, the person starts with low doses of the stacked substances and then
gradually increases the doses for 6 to 12 weeks. In the second half of the
cycle, the doses are slowly decreased to zero. This is sometimes followed by a
second cycle during which the person continues to train, but without drugs.
Abusers believe that pyramiding allows the body time to adjust to the high
doses, and the drug-free cycle allows time for the body's hormonal system to
recuperate. As with stacking, the perceived benefits of pyramiding have not
been substantiated scientifically.
Health consequences associated with anabolic steroid abuse include:
In boys and men, reduced sperm production, shrinking of the testicles,
impotence, difficulty or pain in urinating, baldness, and irreversible breast
enlargement (gynecomastia).
In girls and women, development of more masculine characteristics, such as
decreased body fat and breast size, deepening of the voice, excessive growth
of body hair, and loss of scalp hair, as well as clitoral enlargement.
In adolescents of both sexes, premature termination of the adolescent growth
spurt, so that for the rest of their lives, abusers remain shorter than they
would have been without the drugs.
In males and females of all ages, potentially fatal liver cysts and liver cancer;
blood clotting, cholesterol changes, and hypertension, each of which can
promote heart attack and stroke; and acne. Although not all scientists agree,
some interpret available evidence to show that anabolic steroid abuseparticularly in high doses-promotes aggression that can manifest itself as
fighting, physical and sexual abuse, armed robbery, and property crimes such
as burglary and vandalism. Upon stopping anabolic steroids, some abusers
experience symptoms of depressed mood, fatigue, restlessness, loss of
appetite, insomnia, reduced sex drive, headache, muscle and joint pain, and
the desire to take more anabolic steroids.
In injectors, infections resulting from the use of shared needles or nonsterile
equipment, including HIV/AIDS, hepatitis B and C, and infective endocarditis, a
potentially fatal inflammation of the inner lining of the heart. Bacterial
infections can develop at the injection site, causing pain and abscess.
To encourage youths to avoid anabolic steroid abuse:
Present a balanced picture of what these drugs can do for them and to them.
Most adolescents know that anabolic steroids build muscles and can increase
athletic prowess. Research has shown that failure to acknowledge these
potential benefits creates a credibility problem and can actually make youths
more likely to try the drugs.
Make use of the authority of coaches and the team ethos. In the most
promising program currently under study, coaches and team leaders are
trained to educate team members about the effects of anabolic steroid abuse,
both desirable and adverse, in the general context of training. They also
provide information about nutrition and, of course, exercise and other training
techniques for improving performance without the steroid abuse by as much as
50 percent and also reduces alcohol abuse among teammates.
It is uncertain whether drug testing programs can discourage anabolic steroid
abuse. However, the first scientific studies of this practice are currently under
way.
Access NIDA's specialized Web site, http://www.steroidabuse.gov/. Additional
information on other illicit drugs can be accessed through NIDA's home page on
the World Wide Web: http://www.drugabuse.gov/.
This page accessed 1182917 times since 4/17/00.
NIDA Community Alert Bulletin on Steroid Abuse was published in April, 2000